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� a Town of Barnstable
Post This Card So That it is Visible From the Street—Approved Plans Must be Retained onYJob and'th s Ca - w-- ..,i. -771
awnivs �s�eBuilding
Kept rd Must be
MASa "Posted Until Final Inspection Has Been-Made. ��� ��
Mat" Where a Certificate of Occupancy is Requir`ed,`such Building shall Not be Occupied until a Final Inspection has been made
Permit No. B-18-3810 Applicant Name: Stephen Dickinson Approvals
Date Issued: 11/16/2018 Current Use: Structure
Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 05/16/2019 Foundation:
Location:' 61,PARK AVENUE,CENTERVILLE Map/Lot: 208-008 Zoning District: RD-1 Sheathing:.
Owner on Record: BLIGHT,_GARFIELD P&PHYLLIS C Contractor Name: STEPHEN T DICKINSON framing: 1
Address:. 61 PARK AVE Contractor License -CS-081843 2
CENTE:RVILLE, MA 02632 `L Est. Project Cost: $ 11,856.00 Chimney
Description: Replacing 8 existing DH windows, Like for Like, No change to Permit Fee: $60.47
Header/Structure. " Insulation:
Fee Paid; S 60.47'
Project Review Re like for like Final:
J . q� -Date.•..- il/16/2018
Plumbing/Gas
/ �' ------ Rough Plumbing:. <.. g
Building Official Final Plumbing:
Rough Gas:
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six monthsafter-issuance.
All work authorized by this permit shall conform to the approved application and thelapproved construction documents'for which this permit has been granted. .. Final Gas:
All construction,alterations and changes of use of any building and structures shall 6e in compliance with the local zoning by-laws and codes.
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the
-�
work until the completion of the same. �` ,; � •,• � Electrical
Service:
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit.
Minimum of Five Call Inspections Required for All Construction Work: Rough:
1.Foundation or Footing
2.Sheathing Inspection Final:
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough:
5.Prior to Covering Structural Members.(Frame Inspection)
6.Insulation Low Voltage Final:
7.Final Inspection before Occupancy
Health
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final:
Work shall not proceed until the Inspector has approved the various stages of construction.
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department
Building plans are to be available on site Final:
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT
(3 F-cl Lz�_1.Q r,
TOWN OF BA;RNSTABLE BUILDING PERMIT APPLICATION
Ma Parcel DDT Application
p /
Health Division Date Issued l S
Conservation Division Application Fee
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board -
Historic - OKH Preservation / Hyannis
Project Street Address 61 ��Ii2K1/FN«E
Village �E/VTEiC'V/L LE
Owner. &/Gr17- Address. 61/ /1/1E V/LLF Dad�o�
Telephone 2W-•.32d - 02 7 7 Y
Permit Request �1IV,57RUCT /D X &7&zaa1 t A)717/Dn1
Square feet: 1 st floor: existing proposed 800 2nd floor: existing proposed a Total new 1?0
Zoning District Flood Plain Groundwater Overlay
Project Valuation Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family . Two Family ❑ Multi-Family(# units)
Age of Existing Structure 90 YRS• Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes XNo
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other
Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Y'a0
Number of Baths: Full: existing__ new / Half: existing new
Number of Bedrooms: J existing 0 new
Total Room Count (not including baths): existing 7 new 7 First Floor Room Count
Heat Type and Fuel: XGas ❑Oil ❑ Electric ❑ Other
Central Air: ❑Yes XNo Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No
Detached garage:,existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new - size_
N,F
Attached garage: ❑ existing 0 new size _Shed: ❑ existing ❑ new size _ Other. u
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes ❑ No If yes, site plan review#
Current Use Proposed Use
APPLICANT INFORMATION -
(BUILDER OR HOMEOWNER)
Name —Dm L C/ayr- Telephone Number
Address c &/'IFie bR_ License
kLL�M�/S Home Improvement Contractor
NA D S-3 Worker's Compensation # GV�55-,3/s -0/�
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
-Ls u lb 6&C- AIS Ah el; S"3
SIGNATUR DATE '���l CJ
Tr
" FOR OFFICIAL USE ONLY -
I;
} APPLICATION#
DATE ISSUED
.-MAP/PARCEL NO.,
ADDRESS VILLAGE'
OWNER ,-
DATE OF INSPECTION:
�> F t.t FOUNDATI.ON.J
FRAME -
` INSULATION
:2• - a
r. c
FIREPLACE
ELECTRICAL: ROUGH FINAL _
t
PLUMBING: ROUGH FINAL
tj -GAS: F ROUGH FINAL
FINAL BUILDING` } nr :Y.
DATE CLOSED OUT
i ASSOCIATION PLAN NO.
t
y
Office of Consumer Affairs & Pusiness Regulation - Mass.Gov Page 1 of 1
A CJ/ P
= Office of Consumer Affairs and B siness Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116'
Home Improvement Contractor Registration
u Registration: 158855
Type: Individual
Expiration: 3/10l2016 Tr# 248067
♦. �� 4 v
DARYL C JOSIE
DARYL JOSIE
P.O. BOX 2476 w -
ORLEANS, MA 02653
Update Address and return card.Mark reason for change.
(� Address Renewal Employment Lost Card
SCA 1 w 20M-05111
��c.��m�reotrrucalf/r.n//;C>'l`cuatic�u�ell� i
Office of Consumer Affairs&Business Regulation License or registration valid for individul use only
OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Office of Affairs an Business f C Affaid Busi Regulation
= egistration: 158855 Type: g
xpir • : .:3/10/2016, Individual 10 Park Plaza-Suite 5170
t.a Boston,MA 02116
YL C JOSIE
DARYL JOSIE `
12 COMMERCE D
3 ORLEANS.MA 02
y Undersecretary Not valid without signature
A
f,A
VMassachusetts -Department of Public Safety
Board or-Building Regulations and Standards
Construction Super isor
License: CS-082304
DARYL C JOSIE -
P.O.Bog 2476 t = s
12 Commerce Drive
Orleans MA 02653 ;
,
0_ Expiration
commissioner 11/18/2015
http://services.oca.state.ma.us/hic/liedetai}ls.aspx?txtSearchLN=60141 5/18/2012
�9 1-03:16p Nickerson Home Improvemen 508-255-5107 p.1
h4 ,
I Massachusetts -Departments of Public saret,v
Board of Building Regulations and Standards
�'�>n,atructiull $tiilcr�i•;�.u•Sprci,:lt.,
License: CSSL-101185
rs
MA_R K D NYCKEI2SON . ._..-.,. <
PO BOX.2476 = -
ORLEANS MA 02653
Expiration
10/26/2015
Commissioner
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
• Boston, Massachusetts 02116
Home Improvement Contractor Regi.stration
Registration: 133851
Type: Private Corpc ration
Expiration: 8!17/2015 Trg 241453
NICKERSON HOME IMPROVEMENT _
MARK NICKERSON
P.O. BOX 2476 -
ORLEANS, MA 02653
Update Address and return card.Mark reason for change.
Address j J Renewal _; Emplo ment Lost Card
SCA 1 0 20t•A-05!1 i
!"'��.•'�r:murraurr<r�/�r�:^�%r.:Jirr•�u�r•//
License or registration valid for individul use only
Office of Consumer Affairs&Business Regulation
n; before the expiration date. If found return to:
al TOME IMPROVEMENT CONTRACTOR
l } egistration: 133g51 Type: Office of Consumer Affairs and Business Regulation
10 Park Plaza-Suite 5170
;:ExpiYati n: 8117l2015 Private Corporatia1 Boston,lyfA 02116
NICKERSON HOME IM ROVEMENT
! MARK NICKERSON
f 12 COMMERE DRIVE -o� �—
i . ORLEANS,MA 02653 Undersecretary Not valid without signature
i
,.. - . .
r
The Commonwealth of Massachusetts
Department of IndustrialAccidents
Office of Investigations
d 1 Congress Street,Suite 100
Boston,MA 02114-2017
www mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): j fQ/\/ / /y IN,0 7
Address: /a ,nNlt`6e cll� Z)k• 1,9 j •.&X -7-6
City/State/Zip: 0,1&9¢/1/S Phone#:
Are you an employer?Check the appropriate box: Type of project(required):
1.9 1 am a employer with_6 4. ❑ I am a general contractor and I
employees(full and/or part-time).
* have hired the sub-contractors 6. ❑New construction
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g. ❑ Demolition
working for me in any capacity. employees and have workers' 9. Building addition
[No workers' comp.insurance comp. insurance.
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL 12.❑Roof repairs
insurance required.]t c. 152, §1(4),and we have no 13.0 Other
employees. [No workers'
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. .
Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: j / j��l HU7LIA
Policy#or Self-ins. Lic.#: Gt/C5-3/s Expiration Date:
Job Site Address: 6 C/1/(/E City/State/Zip:�e /7 V//—/ / Do�6c3v
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do Itereby certify under the pains and penalties of perjury that the information provided
`C above is true and correct
Sip-nature: ✓-°f1 �_ Date: V �'
Phone#: t-,F,4 P"
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
r
A'c®M®® CERTIFICATE OF LIABILITY INSURANCE DATE(MM,DD�YYY,
315/2015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER ROGERS&GRAY INS AGCY INC CONTACT
434 RTE 134 ' PrAiorEie . I FAx
E-MAIL
SOUTH DENNIS, MA 02664 A,C E.I. Alc No:
L
. ADDRESS:. .
` INSURERS AFFORDING COVERAGE NAIC If
i
INSURER A: LM Insurance-Co oration 33600
INSURED
MCAS LLC INSURER a:'
DBA NICKERSON HOME IMPROVEMENT* INSURERC:
PO BOX 2476 INSURER D
ORLEANS MA 02653 `
• INSURER E
• INSURER F:
COVERAGES CERTIFICATE NUMBER: 23712039 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE ADDL SUBR - POLICY EFF POLICY EXP -
LTR ( POLICY NUMBER MMIDD MMIDO I LIMITS
COMMERCIAL GENERAL LIABILITY
I EACH OCCURRENCE Is
CLAIMS-MADE OCCUR :� ° DA E TO
RENTED
PREMISES Ea occurrence S
MED EXP(Any one person) S
c , PERSONAL BADVINJURY S
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE Is
POLICY❑JE O- LOC PRODUCTS-COMP/OP AGG S
OTHER: 7.
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT IS
Ea accidert
ANY AUTO BODILY INJURY(Per person) Is
ALL OWNED SCHEDULED
AUTOS AUTOS
° s )• BODILY INJ URY(Per accident) S
NON-OWNED
HIRED AUTOS
AUTOS PROPERTY DAMAGE
Per accident S
I
S
UMBRELLA LIAB HOCCUR EACH OCCURRENCE S `
EXCESS LIAB CLAIMS-MADE _ - - r 'AGGREGATE Is
DED RETENTIONS 5
A WORKERS COMPENSATION WC5-31S-360989-015 3/1/2015 3/1/2016 STATUTE I ERH
AND EMPLOYERS'LIABILITY '
ANY PROPRIETORIPARTNERA7(ECUTIVE YIN -.,t ^�
OFFICER/MeA ER EXCLUDED9 ❑Y NIA ` E.L.EACH ACCIDENT S l OOOOO
(Mandatory in NH) EL DISEASE-EA EMPLOYES 100000
If yes,describe under :
DESCRIPTION OF OPERATIONS below i E.L DISEASE-POLICY LIMIT I S 500000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) -
I
Workers compensation insurance coverage applies only to the workers compensation laws of the state MA. r.
This certificate cancels and supersedes 11previously
r`.
aIssued ce 'fi rn sates only as the relate o w ,t workers compensation coves
Y Y e ,
* P 9
..CERTIFICATE HOLDER t .' CANCELLATION
' TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
ZOO THE EXPIRATION .DATE THEREOF, NOTICE WILL BE DELIVERED IN
200 MAIN STREET MAIN STREET
02601 ACCORDANCE WITH THE POLICY.PROVISIONS.
AUTHORIZED REPRESENTATIVE
LM Insurance Corporation '+
9)1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25.(2014/01) The ACORD.name and logo are registered marks of ACORD '
CERT NO.: 23712039 CLIENTF CODE: 1228681 Anne Chandler 3/5/201S 11:10:S1 M (EST) Page,i of;l
4 ¢ '
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P T .MCAS,�L�LC 2
Il O P o SAL LI st .r h -: z _ y r i !� '
•:ROOFING •SCREEN PORCHES
SIDING �•SECOND'STORIES r a{ ii °508 240-3081 a 12:Commerce Drive
508 255 b107 FAX P.O'BOX 2476
•-DECK S • RENOVATIONS= 653
•ADDITIONS •INTE:RIOR/EXTERIOR:PAINTING Wft mckersonhometmprovement com ORLEANS,,MA 02
•SKYLIGHTS: •WINDOWS/DOORS . E-Mall mark1202653@yahoo corn
•GARAGES = • KITCHEN`&AS
REMODELING
PHONE > DATE
TO: Phyllis:Blight
A
61°Eark.Avenue 4 # x JOB NAME/LOCATION
::. -r S a t r r
.14
Centerville MA 02632
n Arne
9
s .
1S
JOB NUMBER JOB PHONE
Y l r
We hereby submitspeciftcapons a6i estimates for,
> io
Y 3
Remove window
Cut and frame door opening *
Install panel'pme;door Y ,
...
Install moasture resistant slieetrock
Install the underlayment on shower walls and bathroom floor
Tile shower;and bathroom";floor ,
Install vanity
fw
Install glass.shower door(material allowaric16 at$500)
Install bi-fold door:°on linen.closet '
Install shelves.m linen closet'
Install all baseboards and window and custom`door:molding
Apply one coat of primer and two coats of finish paint on all new;work -
Install homeowner-supplied mirror
Supply:all labor,'materials and debris removal estimated°at$39975
Final price based on final'design
Bathroom fixture allowance at$4300
Window molding to be custom made to match existing house as close as possible
Baseboards in bathroom built up to best case scenario
Exterior trim to match existing addition(Azek simple rakes and corners)
Roof to match main house as close as.possible ;
We Propose hereby to furnish material and labor-complete in accordance with the above specifications,for the sum of:-dollars($
Payment to be made as follows:
$2500 deposit requested with accepted proposal
Progress payments upon request balance due upon completion
All material is guaranteed to be as specified.All work to be completed in a professional
manner according to standard practices.Any alteration or deviation from above specifications Authorized
involving extra costs will be executed only upon written orders,and will become an extra Signature
charge over and above the estimate.All agreements contingent upon strikes,accidents or
delays beyond our control.Owner to carry fire,tornado,and other necessary insurance.Our Note: s proposal may be
workers are fully covered by Worker's compensation insurance. withdrawn by usViaot accepted within VS.
Acceptance of Proposal —The above prices,specifications and
conditions are satisfactory and are hereby accepted.You are authorized to do the work '
as specified.Payment will be made as outlined above. Sign _re
Signature
Date of Acceptance:
..,,..- -.,e
FTC r�O�
+ WIM917ABLE,
9� MASS.: ,0� Town of Barnstable
�fD MA'S A �.• °
- Regulatory-Services
'Richard V.Scali,Director
' Building Division
Thomas Perry,CBO .
Building Commissioner `
' y 200 Main,Street, Hyannis,MA 02601-
www.tovdn.ba rn sta ble.m a.us
Office: 508-862-4038 Fax: 508:790`6230 '
Property:Owner Must
'Complete and Sign This Section
If USing A Builder
as Owner of the subject property
hereby authorize � D ®'r �YJ'o�to act on my behalf,
in all matters relative to work'aitthorized by this building permit application for:
(Address of Job)
'-
Signature of Owner Date a -
Print Name
If Property owner is applying for permit,please complete the Homeowners License Exemption Form on the
reverse side.
C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Out]ook\2PIOIDHR\EXPRESS.doc
Revised 040215 '
EASEd (I
AREA Via18t SF
.
� 01 PARK AVENUE
�$' ytiol TING GARAGE AREA
(� Zn LWOF MOW
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mm mu ►'
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81 MUM -
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N PUBLIC.- 1928 BARNSTABLE COUNTY LAYOUT - PLAN BOOL('22 PAGE 93,N
(A.K.A. COUNTY WAY)
1 1 S7942 Wftt,171AG7YAi11E FE f(!YP) 87.56'
1\, I
{ ASSESSORS z
.. 1 I• 'MAP 208 PARCEL 8 L=30.45
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SCALE IN FEET
MPARED Br.• �• _ EASEMENT EXHIBIT PLAN
BARTER NYE'ENGINEERING&SURVEYING 61 PARK AVENUE ;
I Registered Professional Engineers and Laad Surveyors, CENTERVILLE, MA •
i - yannis,Massachusetts'0260I d`'. t J ,
.16 14'" 1%tAIYN BY:So ORAWp1G 140
Mm-7�NoTth Street-3rd Floor,H
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< TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION �.
Map Parcel Application,# D l-DU
Health Division - Date Issued
Conservation Division Application Feel VU4
Planning Dept. Permit FeA��
Date Definitive Plan Approved by Planning Board
Historic - OKH Preservation / Hyannis
CProject Stree At d red ss � 2 1 P A-2V_' A ye N V C
[Village
Owner GA R i=i t:F-L 0 f -P M y LLI S 5 LI G HT Address _5A AQ:-
Telephone y/- _ ;Z 37,779
Permit Request C
0
ym
r�� V
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay :=r
Project Valuation Construction Type ff
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting doLume` ation.
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) ,
Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's ighway,-A Yeti ❑ No
w
Basement Type: ❑ Full ❑Crawl ❑Walkout ❑ Other
Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft)
Number of Baths: Full: existing new Half: existing new
Number of Bedrooms: existing _new
Total Room Count (not including baths):existing new First Floor Room Count
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No
Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_
Attached garage: ❑ existing ❑ new , size.—Shed: ❑ existing ❑ new size _ Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes ❑ No If yes, site plan review#
Current Use Proposed Use
APPLICANT INFORMATION-
(BUILDER OR HOMEOWNER)
Nay- me_ -*PWFi&FL-P Teleplione`Number el y f 3 2.3 X 77 L�
Addr ess 6/ License #
(_' 6:NfCI;V I Li_j Nl D 46 Home Improvement Contractor#
Email Worker's Compensation #
i
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
`SIGNATU DATE
,i
FOR OFFICIAL USE ONLY
APPLICATION #
!' DATE ISSUED
Ir MAP/ PARCEL NO.
' ADDRESS VILLAGE -
i
OWNER
DATE OF INSPECTION:
k; FOUNDATION
t
x FRAME L 13�1� 1 )L
INSULATION gig
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
r FINAL BUILDING
4
r
DATE CLOSED OUT
ASSOCIATION PLAN NO.
s
�t►+E,�,�ti Town of Barnstable
Regulatory Services
9' 'STssBM� Richard V. Scali, Director
qj tG3q• ��
�fo�,,orA Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us -
Office: 508-862-4038 Fax: 508-790-6230
NOTICE TO THE BUILDING DIVISION OF
CHANGE OF CONSTRUCTION SUPERVISOR
I, �b,c{ Ec_y �t �-�-- , owner.of property located at
6 S �7A AJc C�Nrt�ct o�i� ,hereby certify that
is no longer
Construction Supervisor listed on the application for the project under construction as
authorized by building permit# @D 6-M issued on 20_.[�
I understand that the project under construction must cease until a successor licensed
Construction.Supervisor, is submitted on the records of the Building Division.
- PR ERTY OWNER DATE
q/forms/newcontrowner
reference R-5 780 CMR
rev:040414
�G b �4Gz,tL HvL a�1 c C� `b
1 C.J I I•L S C� ��Ly lJ'�'6 fLf�7C�� �� y.
L r
G -�
Town of Barnstable
Regulatory Services
9 '$; Richard V. Scali, Director
163
9
Building Division -
PfD p�'l�' -•,�
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
w.ww.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
NOTIC T® T BUILDING DIVISION OF
LICENSE C07STRUCTI®N SUPERVISOR
r�SS ON OF RESPONSIBILITY
I, Construction Supervisor License
# reby certify that I have as ed responsibility for the project under
construction, as a horized by building permit# , issued to
(property addre s)
on , 201_
The following Q
d cuments are attached:
copy of my Massachusetts State Construction Supervisor's license
or Homeowner's License Exemption form (if applicable)
copy of my Home Improvement Contractor registration(if applicable)
Commonwealth of Massachusetts Workers' Compensation Insurance Affidavit.
Road Bond (if applicable)
LICENSE HOLDER DATE
q/forms/newcontrb
rev:040414
i
Town of Barnstable
Regulatory Services
psrM r Richard V.Scali,Director
�y
t
Building Division
Tom Perry,Building Commissioner
:a �a� 200 Main Street; Hyannis,MA 02601
www.town.barnstable.--us
Office: 508-862-403 8 Fax: 508-790-6230
HOMEOWNER LICENSE Ex1 MON
"Please Print •
rosLocA tort G PA21� �1 V6 . 4—E NT L 2vt -Lt ;Z 3 2-
nnmber sfiut villa.-
w x �AAF16;-L✓J PrgyLLI ,L3L( (SI-T
`nama - home phone# Wadcphonc¥r
♦4
CURRENT MA=G ADDRESS:
city/town state rip code
The current exemption for`homeowners"was extended to include owner-occupied dwellings of six units or less and to allow
homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor_
DEFl MON OR HOMEOWNM
Person(s)who owns a parcel of land on which helshe resides or intends to reside, on which there is,or is intended to be,a one or two-
family dwelling, attached or detached structures accessory to such use and/or farm structures_ A person who constructs more than one
home in a two-year period shall not be considered ahomeowner. Such"homeowner'shall submit to the Building Official on a form
acceptable to the Building Official,that he/she shall be responsible for all such work perfonned under the bt9dingRermit (Section
109.L1) •
nc undersigned`.`homeowner"assumes responsibility for compliance withthe State Bulking Code and other applicable codes,
bylaws,rulms and regulations_ -
The undersigned`homeowner"certifies that helshe understands the Town ofBarnsfable Building Depart:mentminimvm inspection
procedures and requirements and that he/she will comply with said procedures and requi emeafs.
igpa>urc-of Flo coveiia ^� -�..,, _
Approval ofBuild"nigOfficial a
Note: Three-family dwellings containing 35,000 cubic feet or larger will be regnke i to comply with the State Building Code
Section 127.0 Construction Control-
HOMEOWNER'S EMVIMON
The Code states that: 'Any homeowner performing work for which a building permit is'required shall be exempt
from the provisions of this section(Section 109JA-Licensing of construction Supervisors);provided that if the homeowner,
engages a person(s)for hire to do such work,that such Homeowner shall art as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor
(see Appendix Q,Roles&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often
results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot
proceed against the unlicensed person as it Would with a licensed Supervisor. The homeowner acing as Supervisor is
ultimately responsible.
To ensure that the homeowner is My aware of his/her responsibilities,many communities require,as part of the
permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the Iast page
of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in
your community.
Q:\WPFILES7QRNMVxaadmg permit farmslE�RESS.doo
Revised 061313
THE Town of Barnstable
a�
` Regulatory Services
i F
E RAMNSTiMe. E
r nsass . , Richard V.Scab,Director
'��► ' Building Division
Tom Perry,BmIdmg Commissioner
200 Main Street,Hyannis,MA 02601
www.town Barnstable ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Sec ' n
If Using A Builder
I, , as Owner of the roe subject
J P P rtY
hereby authorize to act on my behalf,
in all utters relative to work authorize by,dds building permit application for.
ss of Job)
''''Pool fences and are the responsibility f the applicant.-Pools
are not to be fille27= d
r u�ized before fence is ' d and all final '
inspections are and acceptecb
Signature of Y113.er Signature of Applicant
Print Name Punt Name
Date .
QFoxMs:owrE FERIESsIoreoOLS
T7m Conmroymeakh of-Massadimsetts
R4 partruerrt of Industrial AccideFrts .
fffike-of rMes igadom.
600 WashfngtortYStreet
Y
Baston,MA 02111
wivi:massgavfdin
—Warl;;ers' Cumpens3tnun.Insurance Affidavit$uilderslCantractnrsJEIectdrians/Phnmhers
Applicant Infcunn,atan Please Print Le�lIy
'l`I-1tTI�.��IIS�eSS1�3IlI�t�i�ll./fnr�ic�rTnaj� CG A�FI�� 1� ��-t Co t'�T
A�37dra
�tJitg' Patel g N7t(Lytl.l t,�'1/-� 02&3:�, Phones Q'rf I- 3 73- 27 7
Are you an employer?Checkthe appropriate box: Type of project(required)_
I am a general contractor and I
1-El am a employer with. �• 6_ ar Ne construcfrn<a
employees(full andforpart time* havelvred.the sub contractors
2.❑ I am a sole p%lxietan orpartaer Piste don the attached sheep �+- ❑Remodeling
siup and have no emplaj,,ees. These sub conTiac#ors have g- ❑Demolition,
worlring for.cae iu arty capacity employees audha-,.re wodzers' .
❑nsurances$ . 9. Building addition
1No R;txkreis'comp.insurance corn_ P-i
required_] 5. ❑ We are a corporation audits 1b ❑Electrical repairs nr additions
3•❑ Iamahomeoumes doing anvofk officers have�esercisedtheir 1L❑Plumbingrepairsoradditiom
myself_[No ivarkers'camp- tight of exempfibu per MGL 12_❑Roof repairs
;nc�trance regwaad 7 c.152,§I(4h aadwe have no
emP` yam
t �oworker3' 13-0 Other
o _
comp-insurance required_)
'tknyWEicanteutchecksbosRum also fill outthesectiaabelowshmr g rhak VDaM-e compensafianpaIieyinfbM:ad L ,
#Mrozawnemwhto-s-uLbmit Otis.sffidau•t;nac3thg theyy are dmag all vtcal anti then,ham autsd@e contractoummst snhmit a newaffid2vit ia&cating sash_
tQntractorr 7Put c'h-7r this box must attached in additiaual shot showing thenane of the suircantwfiors and state whether ar nat ihnse eadtieshav e
eMpbyees.Ifthe5Ub-C=tXctt3f3hace empToyers,rhegm=stgm-6&thek wtrkers'c=p.paficg atmmber-
I arrt art erripl�Crr Heat fs pratzdurg irrrrkers'caatlrerrsatforE i�rszrrattca fir ar;}*eirrpFnpees $etvsv is iiTiR paTicy rrrr,3 job nits
inforraafiom
Insurance Company Name:
Pflrcy 44,ar Self-ins_i.ic.4 l xpiratiou Date:
Job Sites Address City/5tafeJ7.tg:
Attach a copy of the workers'compensa&npolicy declaration page(showing the policy number and eL date.
Failure to secure coverage as required under Section 25A of MGL a_152 can lead to the imposition of criminal penalises of a
fine up bo$U.OD OQ andr'or i7T1C �e-arimprisonmeut,as weU as ciO penalties is the form of a STOP WORK€)RDERand a fiae
of up to$250-00 a day against the violator. Be ad-dsed'dm- t a copy of this statement maybe forwarded to the Office of
lavest gations of the DIA€er insurance coverage verificatim
T do kereby eerlffy rutdw thepaftrs and parrs 01]p rtty thatthe iaforuuEtb rprm--hW abmq h&me acid correct
Phone A.
tlffivid um m9y. Do rrat write fa 6m area,&be cam'pieted by city arto n afj`acia£
City or Taww PermditLicense#
Lssuing A rity(ca cie one):
L Board of$eaIth I Buff mg Department 3.Qtp Town Clem 4.Electrical Inspector 5.Phrmbing hLVecfor
6.Other
coact Person Phont 9:
ormation and lastruefions
ter ISZ all I to de wnrIreas'compensation for fieir=pIay=.
Massaclimetts General Laws chzp reQmres crop�� P��
Pmst?a,,tto this stafr ,an Iayee is deed as"_everyPersdn in the smVice of another under any cont-dot ofbire,
express or implied,oral cr wi
7 ."
assoon;corporation or other legal entity,or any two or mare
An�Ivyer is 3efined as"an md�jcinzt parfn mmb�,
of the foregoing engaged is a joint ptise,and inclndmg the legal nrpresenfaiives of a deceased enzpIayer,or the
receiver or trustee of an individual,p%I `ershrp,association or otherIegal entity,employing employees- However the
owner of a.dwm in g house havmgnot ore than three apartments and who resides therein,or the occupant:of the -
dwelling house of another tho employs to do m�airt ance,const��on or repair work on such dwelling house
or on the grounds or bin Epp � ereto ffiZ notbecanse of such employmentbe de to be an employer_"
` agency• shah withhold$te issuance or
MGL chapfor-1�Z,§25C(�also states ii�at,e rg state or local licensing -
renewal of a Iicease or permit to operate a b ess or to constmct bufldings k the coiEmmnnePealth for any
applicant who has not produced acc6pfable evi e�ce of compTiauce h theTn�Ta coYel-age recjua ed"
Additionally. MGL chapter 152,§25CM•states` q er the commonwealth nor any of✓its political subdivisions shall
en intD any contract for fie perfoiimaan cevfpublic unbl acceptable evidence of compliancewifi the insurance-
req=menis of this chapter have been presehi�d to the o ting aufho "
AppIicaa-L ��
Please fill out the-workers'compensation affidavit cbmpletel cherkn g boxes 1hat apply to your sitaaiion and,if
necessary,supply sub-contractor(s)name(s), address(e§)andpli number(g) along with their certrfrcate(s) of
'Partne• s LP)with.no employees other than the
ce sited Liab antes(LLC)or Limited Liab zsbzP (L
msaran L .may�P
manners or partners,are not mgm:ed to cagy workers' cot pensatiQ =cam Ii an LLC or LLP does have
employees, apolicy is required. Be adYise-dtbatthis a$ida-*mayb to tho Departramt of Industrial
Accidents for confirmation of insurance coverage. Also be s 2te to and date the affidavit The affidavit should
d
e eunit or Ii
eisbe' est not theDeparimen
that the application for the ��
c- or town P _ ,
be reirmmed to the �-y aPP
Teri rift ai Accidents. Should you have aay questions regardmg thL-I�w o ifyou are refit to obtain a wormers'
compensation policy,please call the Department at the numb er lisb .Belo Self-insured companies should enter their
self_ir Ur ce lic use number an the appropriate line. ;
1 a,
CRY ar Town.Offi als
r
e be sore that the affidavit is complete a Aprimedle ly. The Depm'tm wins provided a space at the bottom
Pleas -
of the affidavit for you to fin out in the evmnt the Office vestigaiinns has to �naetyouregardingthe applicant
Pleasebom=tnfllinthcpeunitllicrosenwnberwhic w�Ibe used asarefe=elnumber. Imaddidon,anagplicant
that must subn3i'L multiple pennitUc,ense appIicatims" any given year,need only mit one affidavit indicatmg current
p olicy in:fb=&ion.(if necessary)and under"Job S Address"the applicant should "all laca*.ions in (c'ty or.
town)°'A copy of the affidavrt that has b een offic stamped or maimed by the city r:town maybe provided to the
applicant as prooftbat a valid affidavit is on file future pe�uoits or licenses_ A nep� davitmust be filed out each
year.g1he�a home owner or citizen is o - a license or pezmit not ielated io any blsmess cr commercial yEnillie
(fie. a dog license or permit to burn leaves said person is NOT required to ca�Ie#e i affidavit
The Office of lnVCSzeros would ar, youin a&mce for your cooperation and IIld you have any ques c)ns,
please do not heshate to give m a call-
The Dej mr Ys ad&ess,telephan fax nnmmber_ .
' CamMM19FcatttE Of I ch.- s
" eat afludAaei�.ents ,
• �crr��e�fig�fio� �
Bastw�MA MIII
Tf,-1.4 61'1-727-4900 cxt4-06 or I477 MA S&aF
Fax 617 727 774
R.avised4-24-07 ,nas,- g��
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map 6 Parcel 002 pt�plication #
Health Division Date Issued 1Z12_41/y
Conservation Division Application Fee
1
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH Preservation/ Hyannis
Project Street Address 11�, )
Village tC/
Owner f Address
Telephone
Permit Request
lil
tZo
_5 14 W
Square feet:, 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family t/ Two Family ❑ Multi-Family (# units)
Age of Existing Structure Historic House: ❑Yes ❑ No On Old K s Highway: Lges ❑ No
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area (sq.ft.) Basement Unfinished Area .ft)
Number of Baths: Full: existing new Half: existing mew _
Number of Bedrooms: existing _new `
Total Room Count (not including baths): existing new First Floor Room Codr
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No
Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size,_ Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes ❑ o If yes, site plan review#
Current Use Proposed Use
APPLICANT INFORMATION
V4 ___(BUILDER OR HOMEOWNER) Q A — �)
Name Telephone Number
Address V License # 100
0.4vuAK4- oZy- Home Improvement Contractor# � b
Email Worker's Compensation # 14 q�I
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PR JEC WILL BE TAKEN TO
SIGNATURE DATE ��
f V
I��
FOR OFFICIAL USE ONLY
APPLICATION#
DATE ISSUED
MAP/PARCEL NO. -
ADDRESS VILLAGE
OWNER .
'f 'r
DATE OF INSPECTION: _
FOUNDATION
FRAME
INSULATION
FIREPLACE -
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL -
R GAS: ROUGH FINAL _
FINAL BUILDING
QAi T, CLOSED OUT .'
A.SSOION PLAN NO.
p ;
i
r•
Massachusetts -'Department of Public Safety
:
.board of Building Regulations and Standards
Construction Supervisor
License: CS-100988.,
HENRY E CASSDA
8 SHED ROW
WEST YARMOUTH B
J,•�,. ��� >i �`�\ Expiration
Commissioner 11/11/2015
s b Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 153567
Type: Private Corporation
"m Expiration: 12/15/2016 Trtt 259188
CAPE COD INSULATION, INC
HENRY CASSIDY
18 REARDON CIRCLE --
SO, YARMOUTH, MA 02664
Update Address and return card. Mark reason for change,
SCA1 Co 20M"05/11 Address Renewal Employment 0 Lost Card
�e rpa»u��zar2coer��t�c�C%�/�Cu1daC�tr4eltl
C\ office of Consumer Affairs&Business Regulation License or registration valid for individul use only
Rl OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: .
eglstration: 1.53567 Type: Office of Consumer Affairs and Business Regulation
xpiration :.12/:15/201.6 Private Corporation 10 Park Plaza-Suite 5170
Boston,MA 02116
CAPE COD INSULATI;CI:N;;;;INC'._?-'.'
HENRY CASSIDY
18 REARDON CIRCLE":
SO,YARMOUTH,MA 02664 Undersecretary N valid wi tit sign e
The Commonwealth of Massachusetts
Department of Industrial Accidents
W Office of Investigations
a d I Congress Street, Suite 100
a Boston, MA 02114-2017
q, v
www,mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information ff Please Print Legibly
Name (Business/Or 'zatio .n/Individual);
Address' 60 !ZV t& V �I
City/state/Zip' A U��fK�At Phone #; 1�� ''11
Are you an employer? Check Jhe appropriate box: Type of project(required):
1.5'I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7, [] Remodeling
ship and have no employees These sub-contractors have g, ❑ Demolition
working for me in any capacity, employees and have workers'
[No workers' comp, insurance comp, insurance.$ 9, ❑ Building addition
required,] 5, ❑ We are a corporation and its 10,❑ Electrical repairs or additions
3,❑ I am a homeowner doing all work officers have exercised their 11.7 Plumbing repairs or additions
myself. [No workers' comp, right of exemption per MGL
12,❑ Roof repairs
insurance required.] t c, 152; §1(4), and we have no
employees. [No workers' 13,� Other
comp, insurance required.]
*Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit thisl'ffidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees, If the sub-contractors have employees,they must provide their workers comp,policy number.
I am an employer that is providing workers'compensation Insurance for my employees. Below is the policy and job site
Information,
Insurance Company Name;
Policy#or Self-ins, Liiic, Expiration Date:
Job Site Address; V �� City/State/Zip;
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date),
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250,00 a day against the violator. Be advised that,a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby cert�o n r pains and penaltles of perjury that the information provided a ove is t ue and correct,
Si nature, Date;
Phone#.
177"1-
Offlclal use only, Do not write in this area, to be completed by city or town official.
City or Town: Permit/License #
Issuing Authority(circle one):
1. Board of Health 2. Building Department 3, City/Town Clerk 4, Electrical Inspector 5. Plumbing Inspector
6, Other
Contact Person: Phone#:
N.
GOREY, CAPECOD-27. KLIGETT
CERTIFICATE OF LIABILITY INSURANCE DATE(MMIoo/YYYY)
6/1312014
i CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
TIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
OW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
RESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER,
DRTANT; If the certificate holder Is an ADDITIONAL INSURED,the p011cy(les)must be endorsed" If SUBROGATION IS WAIVED,subject to
terms and conditions of the policy, certain policies may require an endorsement, A statement on this certificate does not confer rights to the
ficate holder In Ileu of such endorsements),
:ER CONT
81 Gray Insurance Agency,Inc. NAM
EiecT Barbara DeLawrence
} FAX
9 134 A/C,
No.E8); (A/C No) (877) 816 2156
Dennis,MA 02660 "'A"
'ADDRESS;bdelawrence ro ers ray.com
INSVRER(61 AFFORDING COVERAGE NAIC A
INSURER A;Peerless Insurance Company
INSURERB;COMMERCE INSURANCE COMPANY
Cape Cod Insulation Inc INSURER C:Evanston Insurance Company
18 Reardon Circle INSURER 0:ATLANTIC CHARTER INSURANCE GROUP
South Yarmouth, MA 02664
INSURER E;
INSURER F;
RAGES CERTIFICATE NUMBER; REVISION NUMBER;-
IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
;ATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
IFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
.USIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
TYPE OF INSURANCE POLICY NUMBER MM%D ADDLISUBRI OFF MO%DO E YY LIMITS
COMMERCIAL GENERAL LIABILITY IN-SO WVQ
EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE IX OCCUR CBP8263063 04101l2014 04/01/2015
PREMISES Ea occurrence $ 100,000
MED EXP(Any one person) $ 5,000
PERSONAL&ADV INJURY $ 1,000,000
N'L POLICY
POITAPPL�IES PER: GENERAL AGGREGATE $ 2,000,00
POLICY JECT LOC -
PRODUCTS•COMP/OP AGG $ 2,000,000
OTHER:
TOMOBILE LIABILITY COMBINED SINGLE LIMIT '
$
Ea @ccldenl 1,000,000
ALL OWNED
ANY AUTO 14MMBCKVMK 04/01/2014 04/0112015 BOOILYINJURY(Perperson) $
X SCHEDULED
AUTOS, AUTOS BODILY INJURY(Per accident) $
HIRED AUTOS X NON-OWNED
AUTOS PROPERTY DAMAGE $
Per accident
$
UMBRELLA LIAS X OCCUR
EXCESS LIAR EACH OCCURRENCE . $ 1,000,000
:F CLAIMS-MADE XONJ453514 04101/2014 .04101/2015 AGGREGATE
DEO X RETENTION 10,000 $
RKERS COMPENSATION Aggregate $ 1,000,000
EMPLOYERS'LIABILITY PER ORH
'PROPRIETOR/PARTNERIEXECUTIVE YIN WCA00525904 061310/2014 05130/2015 STATUTE
�ICER/MEMBER EXCLUDED? NIA
ndatory In NH) E.L.EACH ACCIDENT $ 1,000,000
is,describe under . E.L.DISEASE•EA EMPLOYEE $ 1,000,000
;CRIPTION OF OPERATIONS below
E.L.DISEASE•POLICY OMIT $ 1,000,090
y TION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more apace Is required)
Compensation Includes Officers or Proprietors,
iat Insured statue Is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder,
=1CATE HOLDER NAA/ICI ATI/1•I
' �taasa
0
tiC � o
s s
A"CIP I
mass save .,
PERMIT AUTHORIZATION FORM
I, e `J- �� owner of the roe located at:
$ o property rtY
(Owner's Name,printed)
(Property Street Address) (CityfTown)
hereby authorize the Mass Save Home Energy Services Program assigned Participating
Contractor listed below to act on my behalf and obtain a building permit to perform insulation
and/or weatherization work on my property.
Owner's Signature
Date
FOR CSG OFFICE USE ONLY
Conservation Services Group has assigned the following Mass Save Home Energy Services
Participating Contractor to the above referenced project:
eAPF Cob
Participating Contractor Date
ReL12132011
CAPE COD
I-NSULATION
M...0"A4. S'AM6li3 PRAY MIM 401c"969
CAM VIl Rfo9 INW.119H GKING1 - '
1-800-696-6611 r
"['Own of Barnstable ^
Regulatory Services
Building Division
200 Main St
d-;yark,ui.s, MA 0260.1 ,
Cam „ r a
Gam'
eau Buildin Inspector
please acceph is Affidavit as documentation that Cape Cod Insulation, Inc. perfolilied &
P I
jscorl�'pteted tg-lb-isulation and weatherization work at the property listed below. Cape.Cod
�—la, lati�n di is in accordance to the specifications listed on the building permit
application. All work has been inspected by a certified Building Performance Institute
(Bp•l) inspector. All work preformed meets or exceeds federal & Mate Requirements.
Prapezt�Owzler Property Address Viler
Insulation Installed: Fiberglass Cellulose- R-Value Resil•icted' Unrestricted
Ceilings
6 +
Slopes
Moors
Walls
44
Sincerely
He ry L Las. y Jr, President
i_' e Cod h ulati6n, Inc,
Town of
ble *Permit
BAItNsTABtt:, o Expires 6 months from issue date
9�p ,A-S& ,0 Regulatory Services Fee. ,
tFo .�a Thomas F. Geiler,Director
Building Division
Tom Perry, Building Commissioner -P S �`, T
ice.: 508.-862-4038 200 Main Street, Hyannis,MA 02601
508-790-6230 S E P .8 - 2005 �
EXPRESS PERMIT APPLICATION - AN F
RESIDE1vT-T
Not Valid without Red X--Press Imprint ARNSTABLE
reel Number /�
,+Address PTV r l 1 t
, Ft
dential. .Value of Work
.Minimum fee of•$25.00 for work under$6000.00
s Name&Address � S A �
tor's Name 1 -� 2 Z
Telephone Number ,7� -�-�
improvement Contractor License#(if applicable)
ction Supervisor's License#(if applicable) Q 3
can's Compensation Insurance
Check one:
C] I am a sole proprietor
I am the Homeowner.
I have Worker's Compensation Insurance
ce Company Name �• j
S'
an's Comp.Policy#
f Insurance Compliance Certifieate'must be on file.
3equest(check box)
1 Re-roof(stripping old shingles) All construction debris Will be taken
❑Re-roof(not stripping. Going over existing layers of roo
❑ Re-side fl
0 Replacement Windows. U-Value
. (maximum.44) '
°Whati required: Is of this permit does not co mpg
t
P. mpliance with other town departmem regulations i.e.
***Note: Property Historic,Conservation,etc. '
P rty Owner must sign Property Owner Letter of Per
Inc Improvement Contractors License is required_ mission.
re
=pmtra
5004 z
f
oF�HETot, Town of Barnstable
Regulatory Services
vB MASS. 0 Thomas F.Geiler,Director
a 1639' ,0 M Building Division
�ArFD A'S A
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must Complete and Sign This Section If Using,A
Builder
JCL , as Owner of the subject property
hereby authorize e t(�tx to act on my behalf,
in all matters rela&-JJ-(
tive to w au sized by this boil p application for (address of
l ob)
�?a
k -,31- D5
ignature of Owner Date
n/.SOA/.
sus
riot Name z F
J ' ..t.y t Q:FORM&OWNERPERMISSION
Board of Building Regulat�ons an =aniar
One Ashburton Place - Room 1301
Boston. Massachusetts 02109
Home Improvement.Contractor Registration
Registration: 103714
Type: Private Corporation
! , { Expiration: 7/9/2006
PAUL J. CAZEAULT & SONS, INC.
Paul Cazeault `
1031 MAIN ST '
OSTERVILLE, MA 02658
f
Update Address and return card.Mark reason for Chang
Address Renewal C] Employment Lost Card
DPS-CAI 0 SOM-04104•GIOIZ16
1/2. &.1194.1wn(lM.Ghl". 0�✓I�GQddQ�t(L6¢ud ...
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR License or registration valid for intlividul use oulN
RogistratioR:. 103714 before the expiration dale. If found return to:
Board olAsuilding Itcgulatious and Sl:uuhirds
Expiration:;7I9/2006 Unc \shhurUiu Place Itin 1301
;..Type:'Private Corporation 1loslou, ALL 02108
PAUL J.CAZEAULT;B_.SONS,INC'
Paul Cazeault
1031 MAIN S7 _ :''i %' C L—r.'��rs�✓
OSTERVILLE,MA 02658 Administrator
✓�u �oacciicu�uuea c �
o•��'.cuwu�r+wel.�a
Nt BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number: CS 026325
Birthdate: 10/20/1959
Expires: 10/20/2005 Tr.no: 8603.0
Restricted: 00
PAULJ CAZEAULT
1031 MAIN ST zz.-,
OSTERVILLE, MA 02655 Administrator
Board of Buildin eqqulations
One Ashburton Pace, Rm 1301
Boston, Ma 02108-1618
License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 10/20/1959
Number: CS 026325 Expires: 10/20/2005 Restricted TO: 00
PAULJ CAZEAULT
1031 MAIN ST -
OSTERVILLE, MA 02655
Tr.no: 8603.0
Assessor's office(1st Floor): �,rB� � � ��
Assessor's map and lot nu t t� e 6A�- 4 INSTALLEO'N COMP oo.
C-eonservation
` w
of Health(3rd floor)- :. r lY l 1 I4 TITLE
:ENVIRONMENTAL tt
sewage Permit number =�'
Engineering Department 3rd floor)- TOWN REGULATI .639.
House number
Definitive Plan Approved by Planning Board 194
APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2-00 P.M.only
TOWN z, OF BARNSTABLE
BUILDJN : IN SP CTOR
APPLICATION FOR PERMIT TO
TYPE OF CONSTRUCTION
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for arperrmit according to the following.information:
Location
Proposed Use C �.S LG" r 4-
Zoning District 17--� + Fire District `J-G fTfil +
Name of Owner � �L, -J- J i/4 /�//�2(� AfAddress
Name of Builder Address
Name of Architect Address
Number of Rooms Foundation
Exterior Roofing
Floors JALQO Z). Interior
Heating Plumbing
Fireplace Approximate Cost doc ,
Area 3
6-v�ff-
Diagram of Lot and Building with Dimensions Fee
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction.
I
IK'
Name d L
Construction Supervisor's License
HUTCHINSON, PAUL C. & SUSAN
No 35-4-2-6-- Permit For BUILD STORAGE SHED
Single Family Dwelling
Location 61- Park Street
Centerville
Owner. ' Paul C. �& ' Susan Hutchinson
Type of Construction Frame }
Plot ' _( Lot
Permit Granted October -6 , 19 1 9 2 ,
4 � •
Date_ of Inspection
Date Completed �l�`�.� .19
:l
F
r
ZAu, - Ig2g C.ouNT'/ La-/Du'r
_._ 0 LD D EEt-)
__.-....__...__.. 4.0.d
Z A'
X
00
►o,ti � �� ,^_ �� � i o, o �� 5r r� A
......... ���•� 2� SS•�t (deed _ 2
j 1
es
d
1'
0 •
e
I
' I
!v
i
E
Alwil
o� ' �� —. . . _.. _ .fX 3 LANDING, - AZ - 7�6 �RtSe "Z
[ , �` - A --- -- /'l—STEP s
i
40
I
e x�ST t 1'O��.. i•rZ� �#9E NO N ' Q`y4 }9"T•1 G ,W si a.0..IV L
r .�nlT�R f L d. Fr s
r,r
i
t
i
i
l
,
i
it
__.........:......_............
,_..f:......
r/�/�e ��zav��
Assessor's map and lot number ., ... 4� L.�. .
' - SEPTIC SYSTEM MUST BE PyOFTNETO��
Sewage Permit number 1,b ..;/? � INSTALLED IN COMPLIAN, o�
} ARTICLE II STATE s�
WITH AR rBaBasTnnr,E,
House number .
SANITARY CODE AND TO Mb a
0
1 REGULATIONS. °,,�aYpY•a.0
TOWVV N iOF 'BARNSTABLE
s RUIL I G INSPECTOR
a
APPLICATION FOR PERMIT TO ..:.... V s :. .1�Q.:.. .............................................................
TYPE OF CONSTRUCTION .........dam, '�6� .........:........:.........................:.....:..:......:..........................................:.
Sf ........ n..............19.��'
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location .......... '.. ..........PefX.1,C.......:.......A1-11.................rr..�N 4���el!G.4a......::. ......................................... ........
ProposedUse ... ., lX' . %1 :... b�?l.Tlo.)Ll...........................................................................................•............. ......
Zoning District ....c. ......................................Fire District .....
Name of Owner ......Ij!K 4 ...... .....Address ...... .........e le.............. .........
Name of Builder .......f�p.."/ee....... ..................Address ... ...ST,,,...........J.V..k..................
Nameof Architect ................ ....... ...............,:........Address ....................................................................................
Number of Rooms ...................Foundation ......C�?jl/. ......��Q�/�..................................
............................................... ....
Exterior ........&w.-947 .......................................Roofing .......e O/dXG .......................................................
Floors L2.....................................:.........................Interior .... ?1rQSJr y. �Y.!fl trL.............................
Heating ........................:.... ..Plumbing
Fireplace ..:....... d...............................:.................................Approximate Cost ......4!........................................................
Definitive Plan Approved by Planning Board ---------------------____ �0G
- -------19--------. Area .............. ...........................
Diagram of Lot and Building with Dimensions
S_
Fee ... .......................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
V
ILL,
l '
1.
s
w
I hereby, agree'to conform'to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
�'- Name ....... ..... .. . ..... . ............................
Hutchinson, Paul `
20601
' add to
welling
No Permit for ---..
------- -----'
Location ....... ....................
. ------- ....... ------- ' -
' .
' ~
Owner ...........FaPl. ......................
Type of Construction .............fraoua------ '
0
___-----------------------. � /
/
/
P|c* ---------. Lot ----------'
.
/
/
P�nn' Granted p ?G /
ermit ----'^-----.---' . �
- .'� .` �
|�� ~i � !
' ""'= "' Inspection" ^ ^~ � '� ' '
. 66te Completed ��'�^ ���~��� q `
PERMIT REFUSED
___._________-------.. lA—�
'
�
' ---------------.-----------
. ,
—'----------.-------------.,.
~
' -------~----.--.—.—~-------. -
` ----.-------------------.--.
'
'
.
Approved ---------------- lg
�
-------------------------'— '
'
-----------------------~—"''
. * 1. • ,
741
s . . LEGEND -
EXISTING :
Y
" LAUNDRY >: CLO. D
_ O DEN TES EXISTING SMOKE DETECTOR
_ O, DENOTES EX I r i
Co ISTING.CARBON' MONOX DE' DETECTOR
�O EXISTING JF
BATH ,
EXISTING °
,
BUTLER'S
PANTRY
Y ,
i
EXISTING
- a
,.
a
KITCHEN � � �' CLO'.
EXISTI
BEDR00'M
. 2 i
l
' EXISTING
>
DINING a..
AREA
t
i
EXISTING.
EXISTING'
LIVING BOILER
• ,. ., P O WATER HEATER
ROOM ; 0 '
0 EXISTING
EXISTING 1
PORCH BASEMENT
a '
EXISTING
GARFIELD ANo- PHYLLIS BLIGHT *
FIRST FLOOR
i w 61 PARK AVENUE CENTERVILLE
Y114
'_(CL C
( 3/16" NICKERSON -EXISTING FIRST FLOOR PLAN : ' .--;-EXISTING. BASEMENT
ARC Daat®rw , uc
_HOME IMPROVEMENT
new R. CABRAL BUILDER. JUNE 20;5, 1 OF 2
508.255.2589
down ° -
,
CLO. e
r
• • _ �— -1 4 � O DENOTES EXISTING. SMOKE DETECTOR
I— R EXISTING. : 0 DENOTES EXISTING CARBON MONOXIDE DETECTOR
EXISTING BEDROOM b
w BATH,
,;00r
C LO EXISTING 1
OFFICE
t
CEO.
,
,EXISTING
BEDROOM' ,
F
EXISTING
SECOND FLOOR
BLIGHT
<3
. I T
16 -AND D PHYLLISS- GAR-FIFE PHYLLI
61 PARK AVENUE CENTERVILLE
NICKERSON —EXISTING SECOND 'FLOOR. PLAN
ARC Dea(gr�s . uc
HOME IMPROVEMENT
ALAN R. CABRAL BUILDER JUNE 201`5 2 OF 2
5oesas.2see � ..
EXISTING
DWELLING 1��a jn� {
1 7,�4S�4RY Or 0� 11 +TW1` t
4 h Y1y' � i � n
EXISTING
DWELLING
® REAR ELEVATION
( 3/16" = 1' )
H IN
------------
PROPOSED
BATHROOM
ADDITION
FRAMING
1 / / �� /��/� �/ A i � Aj /i
SECTION ff M ff
PROPOSED
RIGHT SIDE BATHROOM ( 1/4" = 1 ' )
ADDITION * VERIFY ALL DETAILS WITH BUILDER
ELEVATION ASPHALT SHINGLES/ ADJUST AS REQUIRED
M ( 3/16" = 1' ) 1/2 PLYWOOD
SHEATHING
10'-0" FOUND. MATCH EXISTING PROVIDE SOLID BLOCKING
ROOF COLOR AT PANEL EDGES PERPENDICULAR
10'-0" BATHROOM ADDITION , 2" x 10" TO FRAMING MEMBERS IN THE
PROVIDE 16 x 8 ** SET TOP OF FOUND. ROOF RAFTERS FIRST TWO JOIST BAYS
" ® 16" O.C. ® 4'-0" (FLOOR & ROOF)
30" x 30" CONTINUOUS TO MATCH EXISTING FIRST FLOOR 12
"
CRAWL SPACE FOOTING
'zZZZ)4t SIMPSON H2.5A
ACCESS -
(� z HURRICANE CLIPS
l o o = 0
1 Q —
. EA. RAFTER
66;' ih Q ( 49 MI TRIM R INSULN MATCH EXISTING
(_vanity NEW I — 2," x 8" TR DETAIL
BATH 0 8" x 5'-0" CEILING JOISTS,
O SOFFIT
CONC, BLOCK EXISTING 16 O.C. VENT
NEW tile m o rn U FROST WALL 0
M Q DWELLING 6" F.G. 2" x 6" x 7'-0"t 1/2" PLYWOOD
36" x 54" 1 : -�O
the shower o X�. CRAWL o INSULATION
STUD WALL EXTERIOR
w/ glass / N DO SPACE 00 2" x 10" (R20) ® 16" O.C. SHEATHING
enclosure 6�6 J TO MATCH EXIST. SOFFIT (RUN CONTINUOUS
+ 2" CONC. FLOOR JOISTS TO ENGAGE SILL &
ryl6 DUST SLAB ® 16 O.C.
existing
® TOP PLATE)
windo NEW existing window 3/4" T & G ADVANTECH
OLINEN to be replaced SUB FLOOR (N & G) PROVIDE SOLID BLOCKING
remato bed 6 ponel PINE Dr. 2" x 6" PT SILL
FULL NAILING PER(METER
EXISTING —F-- ON SEALER BOLTED
— CONCRETE
EXISTING EXISTING DOWEL CRAWL SPACE BLOCK 9" INSUL I ACCESS I **TO MATSET CH
EXISTING
WALL INTO EXISTING FOUNDATION
KITCHEN CONC. BLOCK WALL (R30) I i .. 0\/�\ FIRST FLOOR
FULL SOLID GROUT CORES 5/8 ANCHOR BOLTS L——J ELEVATION
EXISTING - 8" x 5'-0$'
CONC.BASEMENT & W/ IN 1' OF CONCRETE BLOCK 2" CONC. FROST WALL BLOCK
5/871" O.C. MAX LTS
ALL CORNERS FOUNDATION DUST SLAB & W/ IN 1' OF
FOUNDATION USE 3" x 3" x 1/4" ALL CORNERS
PLATE WASHERS
EXISTING 16" x 8" USE 3" x 3° x 1/4"
SOLID GROUT CORES PLATE WASHERS
PLAN CONTINUOUS
BEDROOM CONCRETE SOLID GROUT CORES
( 1/4" = 1' FT'G. (TYP.)
DOWEL CRAWL
* VERIFY ALL DETAILS WITH BUILDER SPACE WALL INTO
PROPOSED ADDITION ADJUST AS REQUIRED EXISTING CONC.
BLOCK FOUND.
FIRST FLOOR WALL
( 1/4 = 1' ) WINDOW SCHEDULE NHI - BLIGHT
KEY ITEM QUA. DECRIPTION ROUGH OPEN'G NOTES
A WINDOW 1 AND. #28410 DH 34 1/8" x 60 7/8" 6 OVER 6 GRILLE
MATCH EXISTING PROPOSED BATHROOM ADDITION
USE.ANDERSEN SERIES 400 H—P WINDOWS OR EQUIVALENT GARFIELD AND PHYLLIS BLIGHT
ALL CONSTRUCTION TO BE PERFORMED IN STRICT EXISTING — OPTI:ONAL INTERIOR / EXTERIOR GRILLE SYSTEM
LIVING — VERIFY ALL ROUGH OPENINGS PRIOR TO CONSTRUCTION 61 PARK AVENUE CENTERVILLE
COMPLIANCE WITH THE MASSACHUSETTS STATE BUILDING
CODE, EIGHTH EDITION AND WOOD FRAME CONSTRUCTION ROOM — VERIFY ALL MILLWORK PRIOR TO PURCHASE —REAR & RIGHT SIDE ELEVATIONS -FOUNDATION PLAN
MANUAL FOR ONE— AND TWO—FAMILY DWELLINGS
FOR EXPOSURE B WIND LOADS — 110 MPH —PROPOSED ADDITION FLOOR PLAN -FRAMING SECTION M
ANY STRUCTURAL ENGINEERING REVIEW, IF NECESSARY, NICKERSON -WINDOW SCHEDULE
ARC DaaVm , LC IS AT THE DISCRETION OF THE BUILDING COMMISSIONER HOME IMPROVEMENT ALAN R. CABRAL BUILDER JUN E 2015
___508.255.2589 __. -AND WILL BE THE RESPONSIBILITY OF THE OWNER , 1 OF 1